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38B-206 (2) r / , IT MI / / I i I / 4 ! ;! — — - .� _ ,I � �. _ 1 " / / T \‘,,,, ,. ,,....„ t r c-\, N IC 1 rs AP U 1 11„ .; a t , I i \ n r( I ._ V V _, _ E IJl. U1 VI co 0 DRAWINGS PROVIDED BY: PRO]ECT DESCRIPTION: SHEET TITLE: NO. DESCRIPTION BY DATE - N m Rainbow Home Improvement Hary and Marian addition rev 9 Pool O 128 Ryan Road Florence, MA 01062 . 413 - 885 -9038 - • 0811212009 10:30 4135988823 TEDDY BEAR POOLS PAGE 02102 ACOfe J DATE (MM1DQ/YYYY) TM, CERTIFICATE OF LIABILITY INSURANCE I 03/30/2009 PROCUCER Phona; (413) 781.2410 Pate 413. 731 -9539 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INSURANCE CENTER OF NEW ENGLAND ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P O BOX 1175 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR WEST SPRINGFIELD MA 010901175 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED I SU - A: Arbellal -u -n0= C. 4,411111MMIIETIMMINI TEDDY REAR POOLS, INC INSURER B: _ _ 41 EAST ST INSURER C; CHICOPEE MA 01020 INSURER D: INSURER E: COVERAGES • THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSuEb OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OP SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED SY PAID CLAIMS, iNSR ADDLI POLIeY GPF9tTI�E POLICY EJO'IfCATtON lTR INSR TYPE OF INSURANCE POLICY NUMBER DATE MOO . ,_ ,,,,,,.,•A• LIMrTS GENERAL LIABILITY 8500036498 04/01/09 04/01/10 EACH OCCURRENCE 3 _ 1,000,000 El COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED a) 3 100 000 PREMISES (Ea ocauren r CLAIMS MADE X OCCUR MED. EXP (Any one person) S 5,000 A PERSONAL 5 AOV INJURY s t001%0001 GENERAL AGGREGATE 3 2,000,000 GEN%AGGREGATE LIMIT APPI,IES PER; PROOUCTS- COMP/OP AGO. $ 2,000,000 POLICY I I PRO 7 LOC JEGr AUTOMOBILE LIABILITY 32176400003 07/01/08 07/01/09 COMBINED SINGLE LIMIT I. ANY AUTO (Esaceldent) $ 1,000,000 III ALL OWNED AUTOS BODILY INJURY © SCHEDULEO (Perperaon) S A X HIRED AUTOS BODILY INJURY I X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ I . _ (Per ecclsent). , GARAGE LIABILITY AUTO ONLY - EA ACCIDENT 5 ANY AUTO OTHER THAN EA ACC 5 .....-- - I AUTO ONLY: AGO 5 I .. . . EXCESS t UMBREL A ^�� U 7 ABILITY I EACH OCCURRENCE :3 ... OCCUR L1 CLAIM, MADE AGGREGATE 1 5 _� DEDUCTIBLE _ S , RETENTION S I $ ..., '+,w.M- W C ST,�7LJ v..«r WORKERS COMPENSATION AND 9104140407 I 04/01/09 04/01/10 X I TORY LIMI . OTHER T S , 1 _ I EMPLOYERS' LIABtUTY EL, EACH ACCIDENT T , $ 500,000 A I ANY PROORICTOMPARTNRtuptACUTNE OA ICRMAIEMaEA exeLUDED7 I E OISEASE•EA EMPLOYEE I s 500,000 I M pa. describe UMW E.L DISEASE -POLICY LIMIT ' $ 500,000 1 SPECIAL PRQ'tS1ONS brow , OTHER: DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION . .. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 24 GAYS WRFTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO WHOM IT MAY CONCERN TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURg3, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Attention: iam 0, Tr , • ACORD 25 (2001/08) Certificate N 41052 I* ACORD CORPORATION 1988 08/12/2009 10:30 4135988823 TEDDY BEAR POOLS PAGE 01/02 Teddy Bear Pools, Inc. . Known By Our Reputation 41 East Street r (413) 594 -2666 • 1- 800.554-BEAR Chicopee, MA 01020 -3562 . . FAX (413) 598 -8823 Hartle Improvement Cont. MA 011889/CT #520951 Ole www.teddybearpools.com ik 0 TEDDY BEAR POOLS C SPAS J / a/ ' / / I0/ I' --r Boar. o :ui ling egul ions an. taniards __`'� One Ashburton Place - Room 1301 ;.Ty Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 111889 Type: Private Corporation Expiration: 2/8/2011 Tr# 279922 TEDDY BEAR POOLS & SPAS INC THEODORE HEBERT --- - -- _ ._._ ___ ..,.. _ ......_. ___ 41 EAST ST CHICOPEE, MA 01020 ---- ...._... —._._ _ .. _. _ _ _.._ Update Address and return card. Mark reason for thange. "' Address Renewal ... - Employment Lost Card DPS.CA1 8 50114.07107.1 00 .. "�,.°`.- y'_._ .:`_1.t" 1.P -"- _'yam ..' _1.,1"-. 4 1-P _ .. f`- '1.:'_.. _'.1.IW_ * AP_ ..t1.,"-1 * t '. ., +' ... ++ X - _� y A' ' gf " ST ATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION :;v-, '. Y - ,,, i s,s Be it known that iR '° ; , , TEDDY BEAR POOLS INC t � : _ 41 4,6S1 ST e CI CC) * ; 1 ,01.020 i 0' I is certified by the Depart a' r aptcorion as a registered i H OME �11�1P ti r ON"I'RAC'TO t '' R �• a - a; i TEDDY BEAR POOLS INC �?!!NSr; _ , . I Effective: 12/01/2008 o � .I y Expiration: 11/30/2009 .:: I . , 'a - .,,,,,._:..________„ 7 4 ;1---A.... i '.,. • ~ Fac e. Cwoaioner i ,e , okay y `, s � �! � .,e r. ( w ,i" f � � 1' w 1 . +Y w t t '� . 1i � y ,. � � � . � •. * � , i � � '� I""P ..✓. E_.. r ..'. -..r . \ .. _ .._ . . -. i � ;. • 'r__ - i ti..- ,. ., ..__ - \ , f, _, f -. 'N._ i,. / �r , , HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 7SOCMR 105.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A. person who constructs more than one home in a two -year period shall not be considered a home owner." The building department for the City of Northampton wants person(s) who seek to use the home owner exemption, to act as their own constructipn supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill). sonot h oles [before pour), a rough bn�ding in spection [bef wor is concealed', insulation ins p etion (if reaaired) and a 'II naf building his nection. The building department requires these inspections before the work is concealed, fail ure to secure these inspectio n ns c result in failure to obtain a certificate of occupancy until the work can be in petted. if the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections, Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above_ ,(Home owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location 90oz ZLZTL85CTt XVI L2:T7T 600Z/TT/80 t. The Commonwealth of Massachusetts Department of lndustr'ial Accidents '1 ulruu. Office of Investigations �" 600 Washington Street O. st= , Boston, 11 02111 .,im : • www.mass.gov/dia Compensation Insurance Affidavit; Builders/ Contractors /Electricians/Plumbers A. • Iicant Information • Please Print L r Name esi/Orga tionnndivide R4 er ' i S ' c , 3 • Address: . / f 5} — — 7 City /State/Zip: 4,,vl ' ' 4,1--,. , 0/6x1) Phone. #: Wj ` C/ / • db Are on an employer ?.Check the appropriate box: Type of project (required). ,, — 1. I am a cm pIoyer with /aa 4.. 0 I am a general contractor and I 6 New construction employees (full and/or part-time).* have hired the sub - contractors 2.0 Z ass a sole proprietor or partner- h on the auached sheet 7. 0 Remodeling ship and no employees These stile- contractors have .2. 0 Demolition working for me in any capacity. rtuplgyecs. and.luave workers' 9_ o gt fig addition _ m'st lce. Na [ workers camp. insurance ro �, _. -_ ._........ gttued:J 5. 0 We are a porpoiat ion and its 10 -0 Electrical repairs or additions h ffi ocers ave' ercised their 3. El I am a homeowner doing all work ] 1.(] Plumbing repairs or additions myself [No workers' comp. rx t of exclnptioti per MQL 12.0 Roof repairs insurance required1 r • c. 152, §1(4), and we have 310 employees: [No workers' • l j Other Ot/e rG'L, ' • cone. insurance recpiired.] . p•rl/ "'Any applit=ult tat checks box #I: must also fill oe the seed= belawsboariag their workers' c rapensaaeo policy inforn ution_ t Home ners who submit this 2f6davit adiaatino they sat doiagall work and then hire outside - contractors must submit a at w affidavit radiating s e.b. *contractors that check this bolt must attached an ad /Rion: t sheet showing the name of the sub�ontract6us sad mesa whether or not time erodes have - employees. If the sub-contractor :have have employees. they mnetprovide their workers' comp_ poky thither_ . I am an employer that isprovldtng workers' compensation insurance for my employees Below Fs the policy and fob - site information. Insurance Company Name: ' i i S ' Policy # or Self-ins. Lic. #: / /O y /Lf v6 i E Darr: 9 ./ — /(J Job Site Address: . ^ f f / A City/Statl;/Zip:' . ( 06 • Attach a copy of the workers' compensation policy .declaration (showing policy number and expiration date). page tixe ollc F a u l u r e to secure coverago: a s required viiiGr Se•tioli 25 A o f 1 U l G Z c.' 152 csti lead t o tlzt: ' _ . Osition ofcrimiae penajties of a fine up to $1 500.00 and/or one-year impzisonmeet, as well as civil .penalties in the form of a STOP WORK ORDER and a aoe of up tb $250:00 a.. day against the violator. Be advised that a copy of this statement may be forwarded to the OiVice of Itivesii - ution• of the DIA..for insurance' coy- • ver;T cation I do here ; .,.::._ by . C erti '• nder • • . . ,• d enalties o • e _ _ .� p fp � uJ' thattheinforntatfanproviderC . abave_issrueandcnrre� : __ -- i IL: 41 �� e Pho ■; ff' y p y d!' . .1. : -._l� .. - U' tciza! use only. Do not write m rs arm to bee bled c or to►vn a rcial City or Town; Permit/License # _ ,. Issuing Authority (circle one): • .1. Board of Health Z. Building Department 3. Cityfrown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other o- Contact Person: Phone #: 500(j Z X d LS :t•T 600Z/11!80 SECTION 8.- CONSTRUCTION SERVICES 8.1 Licensud Construction Supervisor: Not Applicable ❑ g Name of License Holder - 17 ri / rr,, License Number _ ( o cast �Aj � / k . CJ�t O Address Expiration Date q/3 Signat e Telephone 8: Re tere .Home lm ovemen .ointractor Not Applicable ID re r i r �s Company Na Registration Number f / E-7-4/ 5 7 4 . C I Gei � A , - Q /6d 11 - ' /111 Address Expiration Date Telephone y/ 3 5 -- q92644 a° - a 6 I SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c -152, § 25CM) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes No ❑ 11 = oine Owner Exernntion. The current exemption for "homeowners" was extended to include Owner- occuuied Dweilines of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. pefinition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two -veer period shall_ nut be considered a homeowner, Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be responsible for all such work,. erformed under the buildine Hermit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, von may be liable for person(s) you hire to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature 1 ZLZTLt35Tt XV3 L5 tT 60OZ /TT /80 SECTION 6- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) I I Roofing U Or Doors D _ Accessory Bldg. ❑ Demolition El New Signs [U] Decks [[LI Siding [l] Other �• t ' `A � `�" Brief Description of Proposed Work: .' l ' LAI _.A`y‘IJ& G `tf 4 .1' Alteration of existing bedroom Yes • - -J No Adding new bedroom Yes Attached Narrative Renovating unfinished basement , Yes 'NJ No Plans Attached Roll - Sheet 6a ^If ahem+ house and Or addition to exlSting housing. complete the foIIOWinq: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement Or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ["la 1 .4 1 1 U r2U�'�1 '� , as Owner of the subject propetdy hereby authorize (r A k, to act on my behalf, in all Matters relative to work authorized by this building permit application, g ature of Owner Date '® C �i l 0 11,4 1 1 Pt Al . , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. ,fit Ai) &1/ c` h Print Name Signature of Owner /Agent Date . /: ' / COO 12 ZLZTL85CTfi XVd LS: f'T 600Z /11/80 Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning mix column to be filled in by Build Department LotSize i , ,. ,. ..... .__ ......__..__ ........._.; . , . Frontage Setbacks Front - - -- Side L:,._ ...... R' ._• Rear Building Height Bldg. Square Footage } ...., % r- .....__._._.-. Open Space Footage _...__... (Lot area minus bldg & paved 5. t parking) # of Parking,Spaee& ' ' Fill: . & Location) A. Has a Special Permft /Variance /Finding ever been issued for /on the site? NO * DONT KNOW 0 YES O IF YES, date issued:; IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'? KNOW YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO • DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: : C. Do any signs exist on the property? YES 0 NO • IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO a IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading. excavation, or filling) over acre or is it part of a common plan that will disturb over 1 acre? YES O NO • IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Z00 E ZLZTLBSCTI XVd 2,2 :17T 600Z/TT/80 u rrtti r 1 z ��,vg City of Northampton Scat r of f =ermit Butlding, Department Cutt3 cutiDrtveway Pem��t 212 Main Street - Rjg 100 wit&MteliAvaIta'bllity Northampton, MA 01060 TWO Sets of Struittr#ei r?s phone 413 -587 -1240 Fax 413 -587 -1272 Plotlsite flans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 SITE INFORMATION 1 «1 Prope Address; This section to be completed by office q 1 Ma^ ir\a ^ � Map 3 Lot ® Unit ! / • /� Zone Overlay District 1 " 0 /O(0 Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT �(' , � 2.1 Owner ord: c4/ _La-/� {�� 1 s 1Y' - y of Record: E; A J bil- � / I 3 � - 73 7 c,)/ tlet Name ( rint; Trent Mailing Address: �•, t'� elepho ne Signature 2.2 Authorized Agent; Name (Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building / / ,�jy1 (a) Building Permit Fee 2. Electrical v (b) Estimated Total Cost of Construction from (6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number Pt' / . ') ® This Section For Official Use y Date Building Permit Number;_, Issued_ Signature: Building Commissioner/Inspector of Buildings Date TOO Cj ZLZTL85CTb XV3 LS:FT 600Z/TT/80 File # BP- 2010 -0170 APPLICANT /CONTACT PERSON AUBUCHON MARIAN E ADDRESS/PHONE 41 MANHAN ST NORTHAMPTON (413) 586 -3757 Q PROPERTY LOCATION 41 MANHAN ST MAP 38B PARCEL 206 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out p ��jj Fee Paid /a ! c#�7 Typeof Construction: INSTALL 15 X 24 ABOVE GROUND POOL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 111889 3 sets of Plans / Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission _ Permit DPW Storm Water Management Demolition Delay Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. a � -14 BP- 2010 -0170 GIS #: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0170 Project # JS- 2010- 000211 Est. Cost: $7000.00 Fee: $30.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TEDDY BEAR POOLS & SPA 111889 Lot Size(sq. ft.): 4573.80 Owner: AUBUCHON MARIAN E Zoning: URB(100)/ Applicant: AUBUCHON MARIAN E AT: 41 MANHAN ST Applicant Address: Phone: Insurance: 41 MANHAN ST (413) 586 -3757 () Workers Compensation NORTHAMPTONMA01060 ISSUED ON:8/14/2009 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 15 X 24 ABOVE GROUND POOL POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House # Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 8/14/2009 0:00:00 $30.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo